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Bupropion

Bupropion is an antidepressant that is also used in smoking cessation. Its label indicates it for major depressive disorder and for prevention of seasonal depressive episodes, and it carries contraindications that turn on seizure risk.

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Key points

  • The label indicates it for the treatment of major depressive disorder as defined by the Diagnostic and Statistical Manual.
  • It is separately indicated for the prevention of seasonal major depressive episodes in patients with a diagnosis of seasonal affective disorder.
  • It is contraindicated in seizure disorder, and in current or prior diagnosis of bulimia or anorexia nervosa.
  • The dose is increased gradually to reduce seizure risk.

How it works

Bupropion acts differently from the SSRIs, which is why its side effect profile differs and why it is also used outside depression. The practical consequence for a reader is the seizure threshold: the contraindications and the gradual titration both exist because of it, rather than for unrelated reasons.

Safety specific to bupropion

Seizure disorder. Bupropion is contraindicated in seizure disorder. This is a categorical exclusion rather than a caution.

Eating disorders. It is contraindicated in current or prior diagnosis of bulimia or anorexia nervosa. The word prior is doing real work: a history counts, not only a current diagnosis, and this is easily missed when someone reports only what is happening now.

Gradual titration. The label directs increasing the dose gradually to reduce seizure risk. That is the reason a starting dose is not simply a smaller version of the target dose, and why moving faster than instructed is not a shortcut.

Suicidal thoughts and behaviours. The boxed warning records that antidepressants increased the risk of suicidal thoughts and behaviour in children, adolescents and young adults in short-term trials, and that these trials did not show an increase in subjects aged 65 and older. In patients of all ages started on antidepressant therapy the label directs close monitoring for worsening and for emergence of suicidal thoughts and behaviours, and advises families and caregivers of the need for close observation and communication with the prescriber.

When to seek urgent care

A seizure while taking bupropion needs emergency attention. New or worsening suicidal thinking, or unusual changes in behaviour, need to reach the prescriber promptly.

Further reading

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